Non-acute management of asthma

Question 1

what are the goals of treatment?

Answer 1

• minimal” symptoms during day and night
• minimal need for reliever medication
• no attacks (exacerbations)
• no limitation of physical activity
• FEV1 and/or PEF >80% predicted or best

Question 2

closed questions - SANE (4)

Answer 2

Short acting beta agonist/week - BLUE INHALER MORE THAN 2 DAYS AWEEK

Absence school/nursery

Nocturnal symptoms/week
- waking more than one night a week with cough and wheeze

Excertional symptoms/week

Question 3

reliever medication

Answer 3

Short acting beta agonists

Question 4

preventer medication

Answer 4

Inhaled corticosteroids (ICS)

Question 5

add on medications

Answer 5

Long acting beta agonists*
Leukotriene receptor antagonists*
Theophyllines*
Oral steroids

Question 6

step 2 after ICS for <5 year old

Answer 6

lEUKOTRINE -LRTA

Question 7

step 2 for children >5

Answer 7

inhaled LABA

Question 8

maximal dose for children of ICS <12 years old

Answer 8

800 microg

Question 9

first line preventer in <5?

Answer 9

inhaled or LTRA

Question 10

adverse effects of ICS?

Answer 10

Height suppression 0.5-1cm
Oral candidiasis - incorrectly, not brushing teeth
Adrenocortical suppression

Question 11

orange and purple inhaler - whats in them

Answer 11

fluticasone

Question 12

oral steroids can cause?

Answer 12

Hypertension

Cataracts

Question 13

Leukotriene receptor antagonist - what molecule is in it?

Answer 13

Montelukast only

- granules for reluctant toddlers

Question 14

Initial add on preventer

(Step 3)

Answer 14

Add on LABA or LTRA (BTS/SIGN)

Add on LTRA (NICE)

Question 15

what should be added to an inhaled steroid?

Answer 15

LABA

- LTRA <5 yers

Question 16

severe asthma - what are the 2 forms

Answer 16

• truly resistant to therapy

- troublesome asthma - attention seeking, psych issue

Question 17

what are the 2 types of delivery systems of asthma medication?

Answer 17

MDI/spacer

Dry powder device

Question 18

what is the increase of lung composition with using a spacer?

Answer 18

> 20% lung deposit
5% without

4 x MDI drug
shake inhaler between puffs
wash the spacer once a month

Question 19

issues that may arise with deposition in infants?

Answer 19

With a not tightly fitting face mask (0.1%)
Crying during inhalation (1%)
Quietly inhaling (8%).

Question 20

Dry powder devices are licensed in?

Answer 20

over 5’s

• under 8’s can’t use them
• less likely used in males
• receive 20% lung function

Question 21

Benefits of using an MDI

Answer 21

Quieter
Quicker
Valve mechanism
Don’t break down
Portable
Cheaper